脑池造瘘术治疗重型颅脑损伤的临床应用进展

Clinical application of cisternostomy in the treatment of severe traumatic craniocerebral injury

重型颅脑损伤(sTBI)是神经外科常见的急危重症之一,其病情复杂,治疗难度较大,目前以减轻脑水肿和控制颅内压(ICP)作为主要的治疗目标。去骨瓣减压(DC)术和脑室外引流(EVD)术是被广泛用于控制难治性颅内高压的传统手术技术,由于其手术疗效有限,且并发症发生率高、预后较差,学者们一直致力于研究新的手术方式治疗sTBI。脑池造瘘术是一种结合了颅底外科和微血管手术知识治疗sTBI的手术方式,近些年逐渐被临床所接受。本文就脑池造瘘术的生理基础、解剖基础、手术原理、手术疗效的最新研究进展作一综述。

Severe traumatic brain injury(sTBI)is a global healthy problem and one of the most common critical diseases in neurosurgery.It is complicated and very difficult to treat.Over the years,the main goal of management of patients with sTBI has been to relieve brain edema and control the intracranial pressure(ICP).Decompressive craniectomy(DC)and external ventricular drain(EVD)are the treatments that are widely used in refractory high ICP.However,scholars have been working on a new surgical method to treat patients with sTBI,due to the limited therapeutic effect and high incidence of complications.Cisternostomy combines skull base surgery and microvascular surgery in the treatment of sTBI.The clinical application of cisternostomy in the treatment of sTBI is reviewed,which introduces its physiological basis,anatomical foundation,surgical principle and curative effect.